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AHCCCS DFSM Claims Clues - October 2018
Effective date
Oct 1, 2018
Identified
Jun 17, 2026
Summary
Effective 10/1/18, the CMS-1500 billing manual requires an ICD indicator in field 21, where 0 means ICD-10-CM and 9 is no longer accepted, and a claim with that field left blank is returned for correction. Behavioral health providers must not use DSM-4 diagnosis codes, and up to twelve diagnosis codes may be entered in priority order. Crisis services within the first 24 hours (such as H2011, S9484 and S9485) are the responsibility of the RBHA for Medicaid, KidsCare and State Only members, while ED visits for Medicaid and KidsCare members (99281 through 99285) are not considered crisis services.
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What to do
Action · 8 steps
01Effective 2018-10-01: Enter the applicable ICD indicator in the ICD Ind.
02field of CMS-1500 field 21 (0 for ICD-10-CM) and in the indicated area of UB-04 field 66.
03Fill in the diagnosis boxes in order, so diagnosis B is entered before diagnosis C.
04Use Place of Service 02 for telephonic services.
05Crisis codes H2011, S9484 and S9485 within the first 24 hours go to the RBHA for Medicaid, KidsCare and State Only members, and assessment codes H0031, 90791 and 90792 go to ACC/AIHP or the RBHA for integrated members with SMI, per the crisis services table.
06Effective August 16, 2018, claim disputes may be submitted to the Office of Administrative Legal Services through AHCCCS Online, and the dispute must state in detail the factual and legal basis for the dispute and the relief requested.
07Claim disputes are not a venue for corrected claims, documentation requested by DFSM, resubmissions or reconsiderations.
08confirm current applicability with AHCCCS before relying on these rules.
Codes mentioned
H2011S9484S9485H0031H00389079190792T1002T10169928199285
Original notice
AHCCCS DFSM Claims Clues - October 2018
azahcccs.gov · Always check the source before changing claims.
Related changes
See all Arizona Medicaid - AHCCCS changes →AHCCCS DFSM Claims Clues - Updated Correction Notice - Updated Guidance on T1016 Code Allowance fora Provider with a Counseling Facility LicenseMediumEffective May 19, 2025 · Claims & BillingAHCCCS DFSM Claims Clues - November 2018MediumNo effective date · Claims & BillingAHCCCS DFSM Claims Clues - May 2023 - Clarification of Billing Requirements for Behavioral Health Outpatient ClaimsHighEffective May 3, 2023 · Claims & BillingAHCCCS DFSM Claims Clues - May 2023 - Transaction Insight Portal for Outpatient Behavioral Health ProvidersMediumEffective May 9, 2023 · Claims & BillingBrowse every Arizona Medicaid - AHCCCS change in the policy list